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Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients
Published on: June 24, 2019
Effects of endotoxin adsorber hemoperfusion on sublingual microcirculation in patients with septic shock: a
Shih-Hong Chen1,2, Wing-Sum Chan3, Chih-Min Liu4
1Department of Anesthesiology, Taipei Tzu Chi Hospital, No. 289, Jianguo Rd., New Taipei, Taiwan.
Background:
Endotoxins can induce an excessive inflammatory response and result in microcirculatory dysfunction. Polymyxin-B hemoperfusion (PMX-HP) has been recognized to effectively remove endotoxins in patients with sepsis and septic shock, and a rat sepsis model revealed that PMX-HP treatment can maintain a better microcirculation. The primary aim of this study was to investigate the effect of PMX-HP on microcirculation in patients with septic shock.
Methods:
Patients with septic shock were enrolled and randomized to control and PMX-HP groups. In the PMX-HP group, patients received the first session of PMX-HP in addition to conventional septic shock management within 24 h after the onset of septic shock; the second session of PMX-HP was provided after another 24 h as needed.
Results:
Overall, 28 patients finished the trial and were analyzed. The mean arterial pressure and norepinephrine infusion dose did not differ significantly between the control and PMX-HP groups after PMX-HP treatment. At 48 h after enrollment, total vessel density (TVD) and perfused vessel density (PVD) were higher in the PMX-HP group than in the control group [TVD 24.2 (22.1-24.9) vs. 21.1 (19.9-22.9) mm/mm2; p = 0.007; PVD 22.9 (20.9-24.9) vs. 20.0 (18.9-21.6) mm/mm2, p = 0.008].
Conclusions:
This preliminary study observed that PMX-HP treatment improved microcirculation but not clinical outcomes in patients with septic shock at a low risk of mortality. Nevertheless, larger multicenter trials are needed to confirm the effect of PMX-HP treatment on microcirculation in patients with septic shock at intermediate- and high-risk of mortality. Trial registration ClinicalTrials.gov protocol registration ID: NCT01756755. Date of registration: December 27, 2012. First enrollment: October 6, 2013. https://clinicaltrials.gov/ct2/show/NCT01756755.
Insights
Polymyxin-B hemoperfusion (PMX-HP) improved microcirculation in patients with septic shock. This preliminary study found enhanced vessel density with PMX-HP, though clinical outcomes were not significantly affected.
Area of Science:
- Critical Care Medicine
- Sepsis Pathophysiology
- Microcirculation Research
Background:
- Endotoxins trigger inflammatory responses and microcirculatory dysfunction in sepsis.
- Polymyxin-B hemoperfusion (PMX-HP) is known to remove endotoxins and improve microcirculation in animal models.
- The clinical impact of PMX-HP on microcirculation in septic shock patients requires further investigation.
Purpose of the Study:
- To investigate the effect of Polymyxin-B hemoperfusion (PMX-HP) on microcirculation in patients experiencing septic shock.
- To assess whether PMX-HP treatment can improve microcirculatory parameters in septic shock.
Main Methods:
- A randomized controlled trial involving patients with septic shock.
- Patients were assigned to either a control group or a group receiving PMX-HP in addition to standard care.
- PMX-HP treatment involved two sessions within 48 hours of septic shock onset.
Main Results:
- No significant differences in mean arterial pressure or norepinephrine dosage were observed between groups post-treatment.
- Total vessel density (TVD) and perfused vessel density (PVD) were significantly higher in the PMX-HP group at 48 hours.
- TVD increased to 24.2 mm/mm² and PVD to 22.9 mm/mm² in the PMX-HP group compared to controls.
Conclusions:
- PMX-HP treatment demonstrated an improvement in microcirculation, specifically in vessel density, in septic shock patients.
- Clinical outcomes were not significantly improved in this preliminary study, particularly in low-mortality risk patients.
- Larger multicenter trials are necessary to validate these findings in patients with intermediate- and high-risk mortality.
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